Airline travel in sickle-cell disease.

who had been on continuous opiate infusion since September, 1996. Far from the consultants taking umbrage because I pointed out that the patient could not have been in sickle crisis for 6 months, they were happy to discuss with me the way forward. To put a false dichotomy between NHS practice and private practice as Bevan does can work only to the detriment of the patient. NHS consultants and I have cooperated together to wean patients off regular opiates and 6-weekly blood transfusions with amazing results and we have continued to work together on mutual patients. Indeed, one senior colleague of Bevan and myself managed together a sickle-cell anaemia priapism patient. Bevan dismisses the longevity of my clinical experience of sickle-cell disease, but I hardly need apologise that it began even before I went to senior school in 1940 when my brother developed priapism—mother said it was a feature of hemkom/chwecweechwe, the tribal hereditary rheumatic syndrome that I was the first to show was identical with sickle-cell disease. I have been acquainted with sickle-cell pain longer than most doctors in the UK, and when I say routine opiates for sickle crisis are not the way to bring out these patients’ best potential in the long-term I am glad to hear white physicians say the same. When Elizabeth Goodman proved that keterolac was as effective in sickle-crisis pain as morphine, without the latter’s respiratory suppressive effects (and I mentioned it as worthy of trial to take patients off opiate dependence) some UK haematologists retorted by saying “ketorolac has no product licence in the UK for this indication”. White physicians who, at the risk of being misunderstood by Bevan, voice their displeasure at what they see happening on their wards deserve commendation, not condemnation.